Provider Credentialing Coordinator (Remote)

Navitus Health Solutions, LLC; Yuma (AZ); A distancia; USD 28.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro

Referral Bonus Program – up to $750!

Descripción de la vacante

Navitus Health Solutions, LLC seeks a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, and first-level evaluation of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services and support Pharmacy Relations.Contract Analysts to ensure credentialing aligns with regulations and Navitus’ policies.

Formación

• High school diploma or equivalent required; advanced degree preferred.
• Retail pharmacy or managed care setting experience is desirable.
• Experience analyzing medical/pharmacy claims or credentials is highly valued.
• Ability to work independently with telephonic and written communication, data mining, and multi-priority management.

Responsabilidades

• Daily communication with Navitus pharmacy providers and vendors to obtain and review credentials.
• Ensure credentials are recorded in systems and maintained in contract files; audit for compliance.
• Support URAC compliance and policy/procedure updates to reflect new laws and guidance.
• Create reports on credential activity for leadership and committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA) and extract relevant data.
• Assist with administration of pharmacy programs and resolution of processing issues.
• Support annual Fraud, Waste, and Abuse attestations and other required attestations.
• Update systems to reflect data from external databases as needed.
• Assist leadership in determining and implementing network strategies.

Conocimientos

Communication skills

Independent worker

Data analysis

Pharmacy experience

Microsoft Office

Educación

High school diploma

Advanced degree preferred

Herramientas

NCPDP

HMS

DEA databases

State Boards databases

Descripción del empleo

Navitus Health Solutions, LLC seeks a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, and first-level evaluation of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services and support Pharmacy Relations.Contract Analysts to ensure credentialing aligns with regulations and Navitus’ policies.